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Sep 15

Dr Lekich is Only Worried About PFOs Because he Operates in a Day Hospital and Doesn’t Have the Ability to Resuscitate Patients if They Have a Stroke During the Surgery

Yes, as hard to believe as it may seem, this is feedback we have received multiple times as a response where a hole in the heart is dismissed even by health professionals.  We have addressed this topic below.  This is important health information about a serious condition.

What is a PFO (Patent Foramen Ovale)?

A Patent Foramen Ovale (PFO) is a common condition where a small flap-like structure in the heart allows blood to cross over from the right atrium into the left atrium of the heart.  This means that unfiltered venous blood bypasses the filtering of the lungs and mixing with freshly filtered arterial blood for recirculation through the brain and body.

It is normal for a foetus to have this hole as it would naturally close after birth, however for 25% – 30% of people it does not close.  It is not known why only a certain portion of the population retains a PFO.

How can a PFO impact me?

50% of people who have a PFO have no symptoms.

50% of people who have a significantly sized PFO have one or more of the symptoms outlined below.

It is thought that symptoms occur due to deoxygenated venous blood travelling to the brain and arterial system before being filtered by the lungs.  Venous blood has lower concentration of oxygen, pH, glucose and other nutrients as well as increased concentrations of urea and other waste products.  It is not designed to travel to the brain, however, the hole in the heart allows this ‘dirty’ blood to bypass the lungs where it would typically be oxygenated and filtered.

Common symptoms include:

  • fatigue – particularly from working legs
  • strokes or TIAs (mini strokes)
  • migraines with aura
  • pain in the side of your belly, legs, or thighs
  • high blood pressure
  • shortness of breath
  • exercise intolerance
  • brain fog.

PFO and Stroke

People with a PFO are at higher risk of stroke due to foreign particles reaching the brain and blocking a vessel, causing a stroke.  These foreign particles may be a result of:

  • blood clots / DVTs and blood clotting disorders
  • fat associated with fractures of bones, orthopaedic surgery, liposuction surgery
  • amniotic fluid associated with childbirth
  • nitrogen associated with ‘the bends’ and scuba diving.


A stroke occurs when the blood supply to part of the brain is interrupted or reduced, preventing brain tissue from getting oxygen and nutrients. Brain cells begin to die in minutes.  A stroke can cause temporary or permanent disabilities with complications that can include:

  • trouble with talking or swallowing
  • paralysis or loss of muscle movement
  • memory loss and thinking difficulties
  • emotional problems
  • pain, numbness & unusual sensations
  • changes in ability to self-care & engage in life.

Surgery with Dr Lekich

Dr Lekich operates in a fully-licensed, purpose-built, private hospital with overnight stay, Miami Private Hospital.  This facility has the resources and staffing including specialist anaestetists to be able to respond to medical emergencies and is actively supported by the local private and public hospitals where Dr Lekich has worked in the past and has collaborative relationships with many Doctors in these facilities.  Our priority is preventing complications hence the PFO workup. 

Other local large hospitals will readily accept Dr Lekich’s patients for transfer where patients have complicated medical cases or require an increased level of care in an Intensive Care Unit (ICU).  This is very rarely required.

In any case, Dr Lekich firmly believes that when it comes to a PFO and stroke risk, prevention is better than cure.

It is flawed thinking to assume that having access to an onsite ICU can prevent brain damage or other permanent complications from having a stroke during surgery.  Once a stroke occurs it is too late to take actions that may prevent any associated permanent damage.

For this reason, Dr Lekich insists (and will continue to insist regardless of the facilities that he may choose to operate in future) that all his Lipoedema patients have any potential PFOs identified and closed before he will operate on them.

We encourage patients to make proactive and empowered decisions about their health and to advocate for holistic and preventative approach to their healthcare and medical treatments.  Medical treatment does not have to be reactionary and should indeed be preventative where possible.

Dr Lekich’s Lipoedema extraction surgery is aimed at making it minimally invasive with the lowest complication rate and so the fat does not return.

Closing a PFO

In experienced hands, closure of the PFO is a minimally invasive procedure that takes approximately 20 – 30 minutes.   The procedure is performed using a catheter and avoids open heart surgery.  We work alongside cardiologists that can provide closure of a PFO in a cost-effective way if you have Private Health Insurance; where out of pocket costs will be very low if there is evidence of a stroke or mini stroke present on an MRI scan.  If there is no evidence, please ask us about cost effective solutions at your consultation.

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